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Deijns SJ, Broen JCA, Kruyt ND, Schubart CD, Andreoli L, Tincani A, Limper M. The immunologic etiology of psychiatric manifestations in systemic lupus erythematosus: A narrative review on the role of the blood brain barrier, antibodies, cytokines and chemokines. Autoimmun Rev 2020; 19:102592. [PMID: 32561462 DOI: 10.1016/j.autrev.2020.102592] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 05/26/2020] [Indexed: 01/07/2023]
Abstract
INTRODUCTION The aim of this narrative review is to provide an overview of the literature on the possible immunologic pathophysiology of psychiatric manifestations of neuropsychiatric systemic lupus erythematosus (NPSLE). METHODS A systematic search on PubMed was conducted. English studies with full text availability that investigated the correlation between blood-brain barrier (BBB) dysfunction, intrathecal synthesis of antibodies, antibodies, cytokines, chemokines, metalloproteinases, complement and psychiatric NPSLE manifestations in adults were included. RESULTS Both transient BBB-dysfunction with consequent access of antibodies to the cerebrospinal fluid (CSF) and intrathecal synthesis of antibodies could occur in psychiatric NPSLE. Anti-phospholipid antibodies, anti-NMDA antibodies and anti-ribosomal protein p antibodies seem to mediate concentration dependent neuronal dysfunction. Interferon-α may induce microglial engulfment of neurons, direct neuronal damage and production of cytokines and chemokines in psychiatric NPSLE. Several cytokines, chemokines and matrix metalloproteinase-9 may contribute to the pathophysiology of psychiatric NPSLE by attracting and activating Th1-cells and B-cells. DISCUSSION This potential pathophysiology may help understand NPSLE and may have implications for the diagnostic management and therapy of psychiatric NPSLE. However, the presented pathophysiological model is based on correlations between potential immunologic etiologies and psychiatric NPSLE that remain questionable. More research on this topic is necessary to further elucidate the pathophysiology of NPSLE.
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Affiliation(s)
- Sander J Deijns
- University Medical Centre Utrecht and Utrecht University, Utrecht 3584 CX, the Netherlands
| | - Jasper C A Broen
- Regional Rheumatology Centre, Máxima Medical Centre, 5631 BM Eindhoven and 5504 DB, Veldhoven, the Netherlands
| | - Nyika D Kruyt
- Department of Neurology, Leiden University Medical Centre, Leiden 2333 ZA, the Netherlands.
| | - Chris D Schubart
- Department of Psychiatry, Tergooi Ziekenhuis, 1261 AN Blaricum, Hilversum 1213 XZ, the Netherlands.
| | - Laura Andreoli
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili of Brescia, Brescia, BS 25123, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, BS 25123, Italy.
| | - Angela Tincani
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili of Brescia, Brescia, BS 25123, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, BS 25123, Italy; I.M. Sechenov First Moscow State Medical University, Moscow, Russia.
| | - Maarten Limper
- Department of Rheumatology and Clinical Immunology, University Medical Centre Utrecht, Utrecht University, Utrecht 3584 CX, the Netherlands.
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Figueiredo-Braga M, Cornaby C, Bernardes M, Figueiredo M, Mesquita CDS, Costa L, Poole BD. Correlation between physical markers and psychiatric health in a Portuguese systemic lupus erythematosus cohort: The role of suffering in chronic autoimmune disease. PLoS One 2018; 13:e0195579. [PMID: 29659589 PMCID: PMC5901990 DOI: 10.1371/journal.pone.0195579] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 03/26/2018] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that affects a large number of people throughout the world. Anxiety, depression and fatigue are common symptoms of SLE that substantially contribute to decreased quality of life. This study investigates the interplay between physical and psychiatric manifestations of lupus. To this end, an SLE patient cohort was examined for correlations between clinical presentation, laboratory tests, and psychological indicators. METHODS Seventy-two lupus patients were evaluated for psychological status using a battery of instruments, including assessments for fatigue (CFS & FSS), depression (HADS), anxiety (HADS), overall health (SF-36 & PSQI) and intimate relationship satisfaction (RAS & CSI). Scores from these assessments were correlated with lupus clinical profiles and laboratory test values. RESULTS The prevalence of depression in the SLE patient cohort was 41.7%, as measured by the hospital depression and anxiety scale. The study identified that pain (p = 0.001), body mass index (p = 0.026), Chalder's fatigue scale (p < 0.001), fatigue severity scale (p < 0.001), and anxiety (p = 0.001) are all positively correlated with depression in SLE patients. Total complement (CH50) (p = 0.032), and SF-36 physical and mental characteristic assessments are negatively correlated with depression. Longitudinal analysis indicated that the disease related complaint alopecia (p = 0.008) and relationship assessment scale scores (p = 0.004) may also be correlated to depression in SLE patients. Multivariant scrutiny of the clinical and psychosocial characteristics identified the fatigue severity scale (p = 0.026), SF-36 physical function (p = 0.040), physical role function (0.030), and mental health (p = 0.002) as the best indicators directly correlated with depression for the SLE cohort. CONCLUSION These results reveal the influence of physical manifestations of lupus including fatigue, pain, body mass index and anxiety, as well as decreased physical and mental function, on depression. Fatigue is the strongest factor correlated with depression in SLE patients in the cohort. Both physical and social/psychological aspects likely contribute to the depression and anxiety in lupus.
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Affiliation(s)
- Margarida Figueiredo-Braga
- Medical Psychology Unit, Dep. Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, Porto, Portugal
- I3S Instituto de Investigação e Inovação em Saúde, Porto, Portugal
| | - Caleb Cornaby
- Department of Microbiology and Molecular Biology, Brigham Young University, Provo, Utah, United States of America
| | - Miguel Bernardes
- Rheumatology Department, Hospital of São João EPE, Porto, Portugal
| | - Marta Figueiredo
- Medical Psychology Unit, Dep. Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, Porto, Portugal
| | | | - Lúcia Costa
- Rheumatology Department, Hospital of São João EPE, Porto, Portugal
| | - Brian D. Poole
- Department of Microbiology and Molecular Biology, Brigham Young University, Provo, Utah, United States of America
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Abstract
The link between systemic autoimmunity, brain pathology, and aberrant behavior is still a largely unexplored field of biomedical science. Accumulating evidence points to causal relationships between immune factors, neurodegeneration, and neuropsychiatric manifestations. By documenting autoimmunity-associated neuronal degeneration and cytotoxicity of the cerebrospinal fluid from disease-affected subjects, the murine MRL model had shown high validity in revealing principal pathogenic circuits. In addition, unlike any other autoimmune strain, MRL mice produce antibodies commonly found in patients suffering from lupus and other autoimmune disorders. This review highlights importance of the MRL model as a useful preparation in understanding the links between immune system and brain function.
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Affiliation(s)
- Boris Šakić
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, ON, Canada.
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Efthimiou P, Blanco M. Pathogenesis of neuropsychiatric systemic lupus erythematosus and potential biomarkers. Mod Rheumatol 2014. [DOI: 10.3109/s10165-009-0198-5] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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FRAGOSO-LOYO HILDA, ATISHA-FREGOSO YEMIL, NÚÑEZ-ALVAREZ CARLOSA, LLORENTE LUIS, SÁNCHEZ-GUERRERO JORGE. Utility of Interferon-α as a Biomarker in Central Neuropsychiatric Involvement in Systemic Lupus Erythematosus. J Rheumatol 2012; 39:504-9. [DOI: 10.3899/jrheum.110983] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Objective.To assess the utility of interferon-α (IFN-α) in serum and cerebrospinal fluid (CSF) as a biomarker of disease activity in central neuropsychiatric systemic lupus erythematosus (cNPSLE).Methods.Serum and CSF samples were drawn at hospitalization in 34 patients with cNPSLE, 16 surgical SLE, 4 primary neuropsychiatric conditions, and 25 with nonautoimmune conditions, except in 44 non-NPSLE patients in whom only serum was studied. Six months later, serum/CSF and serum samples were taken in 20 cNPSLE and 35 non-NPSLE patients, respectively. SLE activity was assessed at hospitalization, and 6 months later in cNPSLE and non-NPSLE patients. IFN-α was detected by Luminex technology.Results.The mean ± SD age of patients with cNPSLE was 31.4 ± 12.2 years, which was similar across the study groups (p = 0.46). Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) scores among cNPSLE, non-NPSLE, and SLE-surgical patients were 15.3 ± 8.2, 12.4 ± 8.2, and 3.8 ± 1.5, respectively. IFN-α levels in serum were higher in cNPSLE than in nonautoimmune patients (p = 0.02), but were similar to non-NPSLE and SLE-surgical groups. In CSF samples, IFN-α levels were higher in cNPSLE than in nonautoimmune patients (p = 0.03), and were nonsignificantly higher than in SLE-surgical and primary neuropsychiatric patients. Six months later, serum levels of IFN-α did not vary from baseline values despite a significant decrease in SLEDAI-2K score in cNPSLE and non-NPSLE patients. IFN-α levels in the CSF of patients with cNPSLE also remained stable. Among specific cNPSLE syndromes, CSF IFN-α levels were significantly higher among patients with acute confusional syndrome.Conclusion.IFN-α does not seem to represent a useful biomarker of cNPSLE syndromes; its utility in specific cNPSLE manifestations merits further investigation.
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Sakić B. The MRL model: an invaluable tool in studies of autoimmunity-brain interactions. Methods Mol Biol 2012; 934:277-99. [PMID: 22933151 DOI: 10.1007/978-1-62703-071-7_14] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The link between systemic autoimmunity, brain pathology, and aberrant behavior is still largely unexplored field of biomedical science. Accumulating evidence points to causal relationships between immune factors, neurodegeneration, and neuropsychiatric manifestations. By documenting autoimmunity-associated neuronal degeneration and cytotoxicity of the cerebrospinal fluid from disease-affected subjects, the murine MRL model had shown high validity in revealing principal pathogenic circuits. In addition, unlike any other autoimmune strain, MRL mice produce antibodies commonly found in patients suffering from lupus and other autoimmune disorders. This review highlights importance of the MRL model as an indispensible preparation in understanding the links between immune system and brain function.
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Affiliation(s)
- Boris Sakić
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, ON, Canada.
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Kozora E, Filley CM, Zhang L, Brown MS, Miller DE, Arciniegas DB, Pelzman JL, West SG. Immune function and brain abnormalities in patients with systemic lupus erythematosus without overt neuropsychiatric manifestations. Lupus 2011; 21:402-11. [DOI: 10.1177/0961203311429116] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: This study examined the relationship between immune, cognitive and neuroimaging assessments in subjects with systemic lupus erythematosus (SLE) without histories of overt neuropsychiatric (NP) disorders. Methods: In total, 84 subjects with nonNPSLE and 37 healthy controls completed neuropsychological testing from the American College of Rheumatology SLE battery. Serum autoantibody and cytokine measures, volumetric magnetic resonance imaging, and magnetic resonance spectroscopy data were collected on a subset of subjects. Results: NonNPSLE subjects had lower scores on measures of visual/complex attention, visuomotor speed and verbal memory compared with controls. No clinically significant differences between nonNPSLE patients and controls were found on serum measures of lupus anticoagulant, anticardiolipin antibodies, beta 2-glycoproteins, or pro-inflammatory cytokines (interleukin (IL)-1, IL-6, interferon alpha (IFN-alpha), and interferon gamma (IFN-gamma)). Higher scores on a global cognitive impairment index and a memory impairment index were correlated with lower IFN-alpha. Few associations between immune functions and neuroimaging parameters were found. Conclusions: Results indicated that nonNPSLE patients demonstrated cognitive impairment but not immune differences compared with controls. In these subjects, who were relatively young and with mild disease, no relationship between cognitive dysfunction, immune parameters, or previously documented neuroimaging abnormalities were noted. Immune measures acquired from cerebrospinal fluid instead of serum may yield stronger associations.
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Affiliation(s)
- E Kozora
- National Jewish Health, Denver, Colorado, USA; 2Department of Neurology, University of Colorado Denver School of Medicine, Denver, Colorado, USA; 3Department of Psychiatry, University of Colorado Denver School of Medicine, Denver, Colorado, USA; 4Department of Radiology, University of Colorado Denver School of Medicine, Denver, Colorado, USA; 5Department of Rheumatology, University of Colorado Denver School of Medicine, Denver, Colorado, USA; and 6Denver Veterans Affairs Medical Center, Denver, Colorado,
| | - CM Filley
- National Jewish Health, Denver, Colorado, USA; 2Department of Neurology, University of Colorado Denver School of Medicine, Denver, Colorado, USA; 3Department of Psychiatry, University of Colorado Denver School of Medicine, Denver, Colorado, USA; 4Department of Radiology, University of Colorado Denver School of Medicine, Denver, Colorado, USA; 5Department of Rheumatology, University of Colorado Denver School of Medicine, Denver, Colorado, USA; and 6Denver Veterans Affairs Medical Center, Denver, Colorado,
| | - L Zhang
- National Jewish Health, Denver, Colorado, USA; 2Department of Neurology, University of Colorado Denver School of Medicine, Denver, Colorado, USA; 3Department of Psychiatry, University of Colorado Denver School of Medicine, Denver, Colorado, USA; 4Department of Radiology, University of Colorado Denver School of Medicine, Denver, Colorado, USA; 5Department of Rheumatology, University of Colorado Denver School of Medicine, Denver, Colorado, USA; and 6Denver Veterans Affairs Medical Center, Denver, Colorado,
| | - MS Brown
- National Jewish Health, Denver, Colorado, USA; 2Department of Neurology, University of Colorado Denver School of Medicine, Denver, Colorado, USA; 3Department of Psychiatry, University of Colorado Denver School of Medicine, Denver, Colorado, USA; 4Department of Radiology, University of Colorado Denver School of Medicine, Denver, Colorado, USA; 5Department of Rheumatology, University of Colorado Denver School of Medicine, Denver, Colorado, USA; and 6Denver Veterans Affairs Medical Center, Denver, Colorado,
| | - DE Miller
- National Jewish Health, Denver, Colorado, USA; 2Department of Neurology, University of Colorado Denver School of Medicine, Denver, Colorado, USA; 3Department of Psychiatry, University of Colorado Denver School of Medicine, Denver, Colorado, USA; 4Department of Radiology, University of Colorado Denver School of Medicine, Denver, Colorado, USA; 5Department of Rheumatology, University of Colorado Denver School of Medicine, Denver, Colorado, USA; and 6Denver Veterans Affairs Medical Center, Denver, Colorado,
| | - DB Arciniegas
- National Jewish Health, Denver, Colorado, USA; 2Department of Neurology, University of Colorado Denver School of Medicine, Denver, Colorado, USA; 3Department of Psychiatry, University of Colorado Denver School of Medicine, Denver, Colorado, USA; 4Department of Radiology, University of Colorado Denver School of Medicine, Denver, Colorado, USA; 5Department of Rheumatology, University of Colorado Denver School of Medicine, Denver, Colorado, USA; and 6Denver Veterans Affairs Medical Center, Denver, Colorado,
| | - JL Pelzman
- National Jewish Health, Denver, Colorado, USA; 2Department of Neurology, University of Colorado Denver School of Medicine, Denver, Colorado, USA; 3Department of Psychiatry, University of Colorado Denver School of Medicine, Denver, Colorado, USA; 4Department of Radiology, University of Colorado Denver School of Medicine, Denver, Colorado, USA; 5Department of Rheumatology, University of Colorado Denver School of Medicine, Denver, Colorado, USA; and 6Denver Veterans Affairs Medical Center, Denver, Colorado,
| | - SG West
- National Jewish Health, Denver, Colorado, USA; 2Department of Neurology, University of Colorado Denver School of Medicine, Denver, Colorado, USA; 3Department of Psychiatry, University of Colorado Denver School of Medicine, Denver, Colorado, USA; 4Department of Radiology, University of Colorado Denver School of Medicine, Denver, Colorado, USA; 5Department of Rheumatology, University of Colorado Denver School of Medicine, Denver, Colorado, USA; and 6Denver Veterans Affairs Medical Center, Denver, Colorado,
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Loheswaran G, Stanojcic M, Xu L, Sakic B. Autoimmunity as a principal pathogenic factor in the refined model of neuropsychiatric lupus. ACTA ACUST UNITED AC 2010. [DOI: 10.1111/j.1759-1961.2010.00014.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Cytokines and chemokines in neuropsychiatric syndromes of systemic lupus erythematosus. J Biomed Biotechnol 2010; 2010:268436. [PMID: 20617145 PMCID: PMC2896663 DOI: 10.1155/2010/268436] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2010] [Accepted: 05/21/2010] [Indexed: 11/25/2022] Open
Abstract
Neuropsychiatric syndromes of systemic lupus erythematosus (NPSLE) is a life-threatening disorder and early diagnosis and proper treatment are critical in the management of this neuropsychiatric manifestations in lupus. Brain magnetic resonance imaging (MRI), electroencephalogram (EEG), neuropsychological tests, and lumbar puncture are clinical used for the diagnosis of NPSLE. In addition to these tests, cytokine and chemokine levels in CSF have been reported as useful diagnostic marker of NPSLE. Based on the number of recently published studies, this review overviewed the roles of cytokines and chemokines in NPSLE.
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Pathogenesis of neuropsychiatric systemic lupus erythematosus and potential biomarkers. Mod Rheumatol 2009; 19:457-68. [PMID: 19618249 DOI: 10.1007/s10165-009-0198-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2009] [Accepted: 06/09/2009] [Indexed: 10/20/2022]
Abstract
Systemic lupus erythematosus is a chronic, multisystemic, autoimmune disease that may involve the central, peripheral, and autonomic nervous systems and can present with a wide variety of neurological and psychiatric manifestations. In this article, we review the recent literature pertaining to the pathogenesis of neuropsychiatric systemic lupus erythematosus (NPSLE). We searched the PUBMED database with no chronological constraints using the following terms: "neuropsychiatric systemic lupus erythematosus" cross-referenced with the terms "pathogenesis" and "biomarkers" for full-text articles in English. The etiology of NPSLE is as yet unknown, though numerous autoantibodies and cytokines have been suggested as possible mediators. Of the numerous autoantibodies and biomarkers examined, anti-phospholipid, anti-ribosomal P, anti-neuronal, anti-glial fibrillary acidic protein (GFAP), anti-endothelial cell, anti-N-methyl-D: -aspartate (NMDA), microtubule-associated protein 2 (MAP-2), and matrix metalloproteinase-9 (MMP-9) appear to be elevated in patients with NPSLE. Cytokines that may be involved in the pathology of NPSLE include interleukin (IL)-2, IL-6, IL-8, IL-10, tumor necrosis factor (TNF)-alpha, and interferons (IFN)-alpha and -gamma. With continued advances in immunological research, new insights into the pathophysiologic mechanisms of NPSLE may lead to the development of biomarkers and new treatment strategies.
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Mondal TK, Saha SK, Miller VM, Seegal RF, Lawrence DA. Autoantibody-mediated neuroinflammation: pathogenesis of neuropsychiatric systemic lupus erythematosus in the NZM88 murine model. Brain Behav Immun 2008; 22:949-59. [PMID: 18411022 DOI: 10.1016/j.bbi.2008.01.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2007] [Revised: 01/21/2008] [Accepted: 01/21/2008] [Indexed: 10/22/2022] Open
Abstract
Autoantibodies play an important role in central nervous system manifestations of neuropsychiatric systemic lupus erythematosus (NPSLE). Previous studies have shown that the lupus-prone NZM88 strain has major neural deficits and high titers of serum IgG to brain antigens. ELISA was performed to detect the presence of IgG in different brain regions of NZM88 mice and to compare the levels with NZM2758 mice and control strains (NZW and BALB/c). There was a substantial increase of IgG in the substantia nigra (SN) and hypothalamus (HT) of brains from NZM88 mice compared to control NZW and BALB/c mice, whereas NZM2758 mice had more IgG in the cortex. The increased presence of IgG in the NPSLE-prone NZM88 mouse brain was paralleled by increased TNF-alpha and IL-12 in the SN and HT regions; significantly elevated expression of MHC Class-II was also observed in the SN of NZM88 mice and cortex of NZM2758 mice. A co-culture system of dopaminergic neurons and microglia was used to demonstrate that NZM88 sera modifies dopaminergic cell activity only in the presence of microglia and that TNF-alpha is synthesized and released in this co-culture. This study demonstrates a functional link between the autoantibodies, the activation of microglia, and neuronal function associated dopamine production, which is suggested to be causally related to the predominant NPSLE syndromes.
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Affiliation(s)
- Tapan K Mondal
- Biggs Laboratory, Wadsworth Center, New York State Department of Health, Empire State Plaza, Albany, NY 12201-0509, USA
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Prostaglandin E2-mediated dysregulation of proinflammatory cytokine production in pristane-induced lupus mice. Arch Pharm Res 2008; 31:503-10. [PMID: 18449509 DOI: 10.1007/s12272-001-1185-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2007] [Indexed: 02/08/2023]
Abstract
Systemic lupus erythematosus (SLE) is characterized by inflammatory and dysregulatory immune responses including overactive B cells, overproduction of proinflammatory cytokines, and T cell hyperactivity. PGE(2) modulates a variety of immune processes at sites of inflammation, including production of inflammatory cytokines. However, the role of PGE(2) in dysregulatory inflammatory and immune responses in lupus remains unclear. We investigated whether PGE(2) mediates production of inflammatory cytokines in pristane-induced lupus BALB/c mice. Our results showed that levels of serum and BAL PGE(2) and LPS-stimulated production of PGE(2) by peritoneal macrophages were remarkably increased in pristane-induced lupus mice compared to healthy controls. Exogenous PGE(2) enhanced production of IL-6, IL-10, and NO but decreased TNF-alpha by macrophages and augmented IFN-gamma, IL-6, and IL-10 by splenocytes from pristane-induced lupus mice compared to healthy controls. Exogenous PGE(2) also enhanced production of IFN-gamma, IL-6, and IL-10 by thymocytes from pristane-induced lupus mice. Indomethacin (Indo), a PGE(2) synthesis inhibitor, greatly inhibited LPS-induced production of IL-6 and IL-10 by macrophages from pristane-induced lupus mice, while enhanced TNF-alpha. Indo remarkably inhibited Con A-increased production of IFN-gamma, IL-6, and IL-10 by splenocytes and thymocytes from pristane-induced lupus mice. Therefore, our findings suggest that endogenous PGE(2) may mediate dysregulation of production of proinflammatory cytokines, such as IL-6, IL-10, and IFN-gamma, and NO in pristane-induced lupus mice.
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Lee SS, Singh S, Link K, Petri M. High-sensitivity C-reactive protein as an associate of clinical subsets and organ damage in systemic lupus erythematosus. Semin Arthritis Rheum 2008; 38:41-54. [PMID: 18221991 DOI: 10.1016/j.semarthrit.2007.09.005] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2006] [Revised: 05/28/2007] [Accepted: 09/23/2007] [Indexed: 11/18/2022]
Abstract
OBJECTIVE C-reactive protein (CRP) may play an anti-inflammatory role during the acute phase of inflammation and is also used as a marker of inflammation associated with cardiovascular disease. In the present study, we investigated the association between high-sensitivity CRP (hsCRP) and systemic lupus erythematosus (SLE) manifestations, autoantibodies, and organ damage. METHODS In this cross-sectional study, 610 SLE patients from a prospective cohort had more than 1 hsCRP measurement. Organ damage was assessed using the Systemic Lupus International Collaborating Clinics (SLICC)/American College of Rheumatology Damage Index. Multiple linear regression models were used to adjust for age, gender, ethnicity, disease duration, body mass index, education, disease activity, current prednisone dose, statin use, and estrogen use. RESULTS After adjusting for confounders, hsCRP was associated with myocarditis, cardiac murmur, interstitial pulmonary fibrosis, pulmonary hypertension, gastrointestinal lupus manifestations, and anemia. Anti-dsDNA antibodies and lupus anticoagulant were associated with hsCRP in unadjusted models, and these associations remained significant after adjustment for confounders. hsCRP levels were significantly higher in patients with pulmonary, musculoskeletal, and endocrine damage, and a total SLICC Damage Index score>or=1. After adjustment, hsCRP was associated with pulmonary, musculoskeletal, and total damage, but no longer with endocrine damage. CONCLUSIONS hsCRP is associated with a broad range of clinical features and organ damage in SLE, particularly in the pulmonary and musculoskeletal systems. This association holds true independent of sociodemographic, disease activity, and treatment factors and may be useful to identify high-risk SLE patients who would benefit from additional screening and surveillance studies.
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Affiliation(s)
- Shin-Seok Lee
- Visiting Scholar, Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA
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Zandman-Goddard G, Chapman J, Shoenfeld Y. Autoantibodies Involved in Neuropsychiatric SLE and Antiphospholipid Syndrome. Semin Arthritis Rheum 2007; 36:297-315. [PMID: 17258299 DOI: 10.1016/j.semarthrit.2006.11.003] [Citation(s) in RCA: 160] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2006] [Revised: 10/23/2006] [Accepted: 11/23/2006] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We sought (1) to identify and (2) to define the association of all reported antibodies (Abs) with neuropsychiatric lupus (NPSLE), (3) to search for possible mechanisms that are involved in NPSLE, and (4) to determine whether we can recognize a panel of Abs associated with specific neuropsychiatric (NP) manifestations. METHODS A MEDLINE search (1975 to 2005) was performed utilizing the following terms: neuropsychiatric lupus, antiphospholipid syndrome, or central nervous system systemic lupus erythematosus matched with the term antibodies. RESULTS Twenty Abs (11 brain-specific and 9 systemic) were described in NPSLE patients. These include Abs that target brain-specific antigens (neuronal, ganglioside, synaptosomes, glia, methyl-d-aspartate receptors, lymphocytotoxic) and systemic antigens (nuclear, cytoplasmic, phospholipid, endothelial cells). Cognitive impairment, psychosis, and depression were associated with many Abs. Elevated titers of anticardiolipin Abs (aCL) were reported most often and found in patients with cognitive impairment, psychosis, depression, seizures, chorea, and migraine. No specificity was encountered among brain-specific or systemic Abs for any single NP manifestation. No studies evaluated a specific NP manifestation with the full panel of 20 Abs. A panel of brain-specific and systemic Abs may be helpful in establishing the diagnosis of NPSLE. Postulated mechanisms in experimental models included vascular occlusion and injury by pathogenic Abs in a disrupted blood brain barrier. CONCLUSIONS NPSLE is associated with brain-specific and systemic Abs. Cognitive impairment, psychosis, and depression were associated with many Abs, including aCL Abs. Possible mechanisms include vascular occlusion and injury by pathogenic Abs in a disrupted blood brain barrier.
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Affiliation(s)
- Gisele Zandman-Goddard
- Lecturer of Internal Medicine, Sackler Faculty of Medicine, Tel-Aviv University, Israel; Head of the Department of Medicine C, Wolfson Medical Center, Holon, Israel
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Ballok DA. Neuroimmunopathology in a murine model of neuropsychiatric lupus. ACTA ACUST UNITED AC 2006; 54:67-79. [PMID: 17223198 PMCID: PMC2577581 DOI: 10.1016/j.brainresrev.2006.12.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2006] [Revised: 12/09/2006] [Accepted: 12/11/2006] [Indexed: 01/18/2023]
Abstract
Animal models are extremely useful tools in defining pathogenesis and treatment of human disease. For many years researchers believed that structural damage to the brain of neuropsychiatric (NP) patients lead to abnormal mental function, but this possibility was not extensively explored until recently. Imaging studies of NP-systemic lupus erythematosus (SLE) support the notion that brain cell death accounts for the emergence of neurologic and psychiatric symptoms, and evidence suggests that it is an autoimmunity-induced brain disorder characterized by profound metabolic alterations and progressive neuronal loss. While there are a number of murine models of SLE, this article reviews recent literature on the immunological connections to neurodegeneration and behavioral dysfunction in the Fas-deficient MRL model of NP-SLE. Probable links between spontaneous peripheral immune activation, the subsequent central autoimmune/inflammatory responses in MRL/MpJ-Tnfrsf6(lpr) (MRL-lpr) mice and the sequential mode of events leading to Fas-independent neurodegenerative autoimmune-induced encephalitis will be reviewed. The role of hormones, alternative mechanisms of cell death, the impact of central dopaminergic degeneration on behavior, and germinal layer lesions on developmental/regenerative capacity of MRL-lpr brains will also be explored. This model can provide direction for future therapeutic interventions in patients with this complex neuroimmunological syndrome.
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Affiliation(s)
- David A Ballok
- Department of Psychiatry and Behavioral Neurosciences, HSC Rm 4N4, McMaster University, 1200 Main St. West, Hamilton, Ontario, Canada L8N 3Z5.
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16
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Sakic B, Kirkham DL, Ballok DA, Mwanjewe J, Fearon IM, Macri J, Yu G, Sidor MM, Denburg JA, Szechtman H, Lau J, Ball AK, Doering LC. Proliferating brain cells are a target of neurotoxic CSF in systemic autoimmune disease. J Neuroimmunol 2005; 169:68-85. [PMID: 16198428 PMCID: PMC1634761 DOI: 10.1016/j.jneuroim.2005.08.010] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2005] [Accepted: 08/01/2005] [Indexed: 12/31/2022]
Abstract
Brain atrophy, neurologic and psychiatric (NP) manifestations are common complications in the systemic autoimmune disease, lupus erythematosus (SLE). Here we show that the cerebrospinal fluid (CSF) from autoimmune MRL-lpr mice and a deceased NP-SLE patient reduce the viability of brain cells which proliferate in vitro. This detrimental effect was accompanied by periventricular neurodegeneration in the brains of autoimmune mice and profound in vivo neurotoxicity when their CSF was administered to the CNS of a rat. Multiple ionic responses with microfluorometry and protein peaks on electropherograms suggest more than one mechanism of cellular demise. Similar to the CSF from diseased MRL-lpr mice, the CSF from a deceased SLE patient with a history of psychosis, memory impairment, and seizures, reduced viability of the C17.2 neural stem cell line. Proposed mechanisms of cytotoxicity involve binding of intrathecally synthesized IgG autoantibodies to target(s) common to different mammalian species and neuronal populations. More importantly, these results indicate that the viability of proliferative neural cells can be compromised in systemic autoimmune disease. Antibody-mediated lesions of germinal layers may impair the regenerative capacity of the brain in NP-SLE and possibly, brain development and function in some forms of CNS disorders in which autoimmune phenomena have been documented.
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Affiliation(s)
- Boris Sakic
- Department of Psychiatry and Behavioural Neurosciences, HSC Rm 4N81, McMaster University, 1200 Main St. West, Hamilton, Ontario, Canada L8N 3Z5
- * Corresponding author. Tel.: +1 905 525 9140x22617, 22850; fax: +1 905 522 8804. E-mail addresses: (B. Sakic), (D.L. Kirkham), (D.A. Ballok), (J. Mwanjewe), (I.M. Fearon), (J. Macri), (G. Yu), (M.M. Sidor), (J.A. Denburg), (H. Szechtman), (J. Lau), (A.K. Ball), (L.C. Doering)
| | - David L. Kirkham
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Canada
| | - David A. Ballok
- Department of Psychiatry and Behavioural Neurosciences, HSC Rm 4N81, McMaster University, 1200 Main St. West, Hamilton, Ontario, Canada L8N 3Z5
| | - James Mwanjewe
- Department of Medicine, McMaster University, Hamilton, Canada
| | - Ian M. Fearon
- Department of Biology, McMaster University, Hamilton, Canada
| | - Joseph Macri
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Canada
| | - Guanhua Yu
- Department of Psychiatry and Behavioural Neurosciences, HSC Rm 4N81, McMaster University, 1200 Main St. West, Hamilton, Ontario, Canada L8N 3Z5
| | - Michelle M. Sidor
- Department of Psychiatry and Behavioural Neurosciences, HSC Rm 4N81, McMaster University, 1200 Main St. West, Hamilton, Ontario, Canada L8N 3Z5
| | | | - Henry Szechtman
- Department of Psychiatry and Behavioural Neurosciences, HSC Rm 4N81, McMaster University, 1200 Main St. West, Hamilton, Ontario, Canada L8N 3Z5
| | - Jonathan Lau
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Canada
| | - Alexander K. Ball
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Canada
| | - Laurie C. Doering
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Canada
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17
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Sakic B, Hanna SE, Millward JM. Behavioral heterogeneity in an animal model of neuropsychiatric lupus. Biol Psychiatry 2005; 57:679-87. [PMID: 15780857 PMCID: PMC1635785 DOI: 10.1016/j.biopsych.2004.11.037] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2004] [Revised: 11/17/2004] [Accepted: 11/22/2004] [Indexed: 12/19/2022]
Abstract
BACKGROUND Various psychiatric manifestations of unknown etiology are common in systemic autoimmune disease lupus erythematosus (SLE). Profound heterogeneity at clinical and neuropathological levels suggests distinct subpopulations of SLE patients and multiple mechanisms in the pathogenesis of aberrant behavior. Using inbred mice prone to SLE-like condition, we presently examine whether subpopulations of diseased mice can be identified on the basis of their behavioral performance. METHODS Hierarchical cluster analysis was used to classify 105 MRL-lpr males into clusters. Multivariate analysis of variance (MANOVA) and discriminant function analysis were used to detect overall differences and identify discriminative variables. RESULTS Cluster 1 was characterized by blunted responsiveness to palatable stimulation, as well as increased spleen mass and serum levels of interleukin-1. Cluster 2 comprised of animals with reduced ambulation speed and enlarged spleen. Mice from cluster 3 showed profound dilatation of brain ventricles, reduced brain mass, impaired nutrition and performance in task reflective of emotional reactivity. CONCLUSIONS Present results suggest that systemic autoimmunity compromises brain function via non-Mendelian mechanisms. Although neuroactive cytokines may impair reward systems, brain atrophy seems to underlie deficits in ingestive behavior and emotional reactivity. This study supports the hypothesis that multiple neuroimmunological pathways are involved in the etiology of aberrant behavior during SLE-like disease.
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Affiliation(s)
- Boris Sakic
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Ontario, Canada.
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18
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Trysberg E, Blennow K, Zachrisson O, Tarkowski A. Intrathecal levels of matrix metalloproteinases in systemic lupus erythematosus with central nervous system engagement. Arthritis Res Ther 2004; 6:R551-6. [PMID: 15535833 PMCID: PMC1064867 DOI: 10.1186/ar1228] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2004] [Revised: 06/15/2004] [Accepted: 07/23/2004] [Indexed: 11/10/2022] Open
Abstract
Symptoms originating from the central nervous system (CNS) occur frequently in patients with systemic lupus erythematosus (SLE), and CNS involvement in lupus is associated with increased morbidity and mortality. We recently showed that neurones and astrocytes are continuously damaged during the course of CNS lupus. The matrix metalloproteinases (MMPs) are a group of tissue degrading enzymes that may be involved in this ongoing brain destruction. The aim of this study was to examine endogenous levels of free, enzymatically active MMP-2 and MMP-9 in cerebrospinal fluid from patients with SLE. A total of 123 patients with SLE were evaluated clinically, with magnetic resonance imaging of brain and cerebrospinal fluid (CSF) analyses. Levels of free MMP-2 and MMP-9 were determined in CSF using an enzymatic activity assay. CSF samples from another 22 cerebrally healthy individuals were used as a control. Intrathecal MMP-9 levels were significantly increased in patients with neuropsychiatric SLE as compared with SLE patients without CNS involvement (P < 0.05) and healthy control individuals (P = 0.0012). Interestingly, significant correlations between MMP-9 and intrathecal levels of neuronal and glial degradation products were noted, indicating ongoing intrathecal degeneration in the brains of lupus patients expressing MMP-9. In addition, intrathecal levels of IL-6 and IL-8--two cytokines that are known to upregulate MMP-9--both exhibited significant correlation with MMP-9 levels in CSF (P < 0.0001), suggesting a potential MMP-9 activation pathway. Our findings suggest that proinflammatory cytokine induced MMP-9 production leads to brain damage in patients with CNS lupus.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Brain/enzymology
- Brain/pathology
- Central Nervous System Diseases/cerebrospinal fluid
- Central Nervous System Diseases/enzymology
- Central Nervous System Diseases/etiology
- Central Nervous System Diseases/pathology
- Cerebrospinal Fluid Proteins/analysis
- Enzyme Induction
- Female
- Glial Fibrillary Acidic Protein/cerebrospinal fluid
- Humans
- Interleukin-6/cerebrospinal fluid
- Interleukin-8/cerebrospinal fluid
- Leukocytosis/etiology
- Lupus Erythematosus, Systemic/cerebrospinal fluid
- Lupus Erythematosus, Systemic/complications
- Lupus Erythematosus, Systemic/enzymology
- Lupus Erythematosus, Systemic/pathology
- Magnetic Resonance Imaging
- Male
- Matrix Metalloproteinase 2/cerebrospinal fluid
- Matrix Metalloproteinase 9/cerebrospinal fluid
- Meningitis, Aseptic/cerebrospinal fluid
- Meningitis, Aseptic/enzymology
- Meningitis, Aseptic/etiology
- Middle Aged
- Myelitis, Transverse/cerebrospinal fluid
- Myelitis, Transverse/enzymology
- Myelitis, Transverse/etiology
- Nerve Tissue Proteins/cerebrospinal fluid
- Psychotic Disorders/cerebrospinal fluid
- Psychotic Disorders/enzymology
- Psychotic Disorders/etiology
- Seizures/cerebrospinal fluid
- Seizures/enzymology
- Seizures/etiology
- tau Proteins
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Affiliation(s)
- Estelle Trysberg
- Department of Rheumatology and Inflammation Research, Göteborg University, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Kaj Blennow
- Institute of Clinical Neuroscience, Göteborg University, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Olof Zachrisson
- Institute of Clinical Neuroscience, Göteborg University, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Andrej Tarkowski
- Department of Rheumatology and Inflammation Research, Göteborg University, Sahlgrenska University Hospital, Göteborg, Sweden
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19
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Abstract
PURPOSE OF REVIEW This review deals with new information related to central nervous system lupus, with special emphasis on mechanisms engaged in inflammation and neurodegeneration. RECENT FINDINGS We report the very recent findings related to neuropsychiatric lupus in areas of (1) neuroimaging, (2) immunology and genetics, (3) biochemistry, and (4) neuropsychological tests. The relation between treatment of central nervous system lupus and immunologic/biochemical parameters as an outcome variable is also reported. SUMMARY The recent advances in the field of neuropsychiatric lupus allow better understanding of the pathogenesis of the disease and follow-up of disease activity during immunosuppressive treatment.
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Affiliation(s)
- Estelle Trysberg
- Department of Rheumatology and Inflammation Research, Göteborg University, Sahlgrenska University Hospital, Göteborg, Sweden
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20
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Jönsen A, Bengtsson AA, Nived O, Ryberg B, Truedsson L, Rönnblom L, Alm GV, Sturfelt G. The heterogeneity of neuropsychiatric systemic lupus erythematosus is reflected in lack of association with cerebrospinal fluid cytokine profiles. Lupus 2004; 12:846-50. [PMID: 14667101 DOI: 10.1191/0961203303lu472sr] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The objective was to study the occurrence of autoantibodies and cytokines in serum and cerebrospinal fluid (CSF) in neuropsychiatric systemic lupus erythematosus (NPSLE). In total, 28 consecutive patients with NPSLE and 16 systemic lupus erythematosus (SLE) patients without neuropsychiatric involvement (non-NPSLE) were studied. IFN-alpha, IL-6, IL-10, soluble terminal complement complex (TCC), anti-ribosomal P protein antibodies (anti-P) and anti-cardiolipin antibodies (aCL) were measured in serum and CSF by immunoassays. Analyses of white blood cell differential count, CSF-albumin/serum-albumin ratio, IgG-index in CSF and isoelectric focusing in serum and CSF were also performed. CSF specimens from 23 healthy individuals were used as controls. IFN-alpha was elevated in the CSF of 5 of 28 NPSLE patients compared to three of 14 among the non-NPSLE patients. IL-6 was elevated in CSF in three of 26 NPSLE patients. Normal concentration of IL-10 was found in CSF in all 27 NPSLE-patients analysed. IFN-alpha in serum was elevated in 18 of 28 NPSLE patients. No distinct clinical phenotype was related to elevated cytokine concentration in serum or CSF. One patient with cerebral involvement complicated by progressive multifocal leukoencephalopathy displayed a very high IFN-alpha concentration in serum. High concentration of TCC was present in CSF from only one patient with systemic vasculitis and focal cerebral symptoms. In conclusion, the results of this study suggest that the diagnostic value of serum and CSF concentrations of IFN-alpha, IL-10, IL-6 and TCC is limited in unselected neuropsychiatric SLE, probably due to the heterogeneity of NPSLE pathogenesis.
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Affiliation(s)
- A Jönsen
- Department of Rheumatology, Lund University Hospital, Lund, Sweden.
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21
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Trysberg E, Höglund K, Svenungsson E, Blennow K, Tarkowski A. Decreased levels of soluble amyloid beta-protein precursor and beta-amyloid protein in cerebrospinal fluid of patients with systemic lupus erythematosus. Arthritis Res Ther 2004; 6:R129-36. [PMID: 15059276 PMCID: PMC400431 DOI: 10.1186/ar1040] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2003] [Revised: 12/22/2003] [Accepted: 01/07/2004] [Indexed: 11/10/2022] Open
Abstract
Symptoms originating from the central nervous system (CNS) frequently occur in patients with systemic lupus erythematosus (SLE). These symptoms are extremely diverse, including a state of dementia. The aim of this study was to examine the cerebrospinal fluid (CSF) content of soluble molecules indicating axonal degeneration and amyloidogenesis. One hundred and fourteen patients with SLE and age-matched controls were evaluated clinically, with magnetic resonance imaging of the brain and CSF analyses. Levels of tau, amyloid precursor protein (APP), beta-amyloid protein (Abeta42), and transforming growth factor beta (TGF-beta) were all determined using sandwich ELISAs.APP and Abeta42 levels were significantly decreased in SLE patients irrespective of their CNS involvement, as compared with healthy controls. Patients with neuropsychiatric SLE who underwent a second lumbar puncture following successful cyclophosphamide treatment showed further decreases of Abeta42. CSF-tau levels were significantly increased in SLE patients showing magnetic resonance imaging-verified brain pathology as compared with SLE patients without such engagement. Importantly, tau levels displayed significant correlation to Abeta42 levels in the CSF. Finally, TGF-beta levels were significantly increased in patients with neuropsychiatric SLE as compared with those without. Low intrathecal levels of Abeta42 found in SLE patients seem to be a direct consequence of a diminished production of APP, probably mediated by heavy anti-inflammatory/immuno-suppressive therapy. Furthermore, our findings suggest that CSF tau can be used as a biochemical marker for neuronal degeneration in SLE. Finally, the increased TGF-beta levels observed may support a notion of an ongoing anti-inflammatory response counteracting tissue injury caused by CNS lupus.
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Affiliation(s)
- Estelle Trysberg
- Department of Rheumatology and Inflammation Research, Göteborg University, Sahlgrenska University Hospital, Göteborg, Sweden.
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22
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Garthoff LH, Sobotka TJ. From farm to table to brain: foodborne pathogen infection and the potential role of the neuro-immune-endocrine system in neurotoxic sequelae. Nutr Neurosci 2002; 4:333-74. [PMID: 11845817 DOI: 10.1080/1028415x.2001.11747373] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The American diet is among the safest in the world; however, diseases transmitted by foodborne pathogens (FBPs) still pose a public health hazard. FBPs are the second most frequent cause of all infectious illnesses in the United States. Numerous anecdotal and clinical reports have demonstrated that central nervous system inflammation, infection, and adverse neurological effects occur as complications of foodborne gastroenteritis. Only a few well-controlled clinical or experimental studies, however, have investigated the neuropathogenesis. The full nature and extent of neurological involvement in foodborne illness is therefore unclear. To our knowledge, this review and commentary is the first effort to comprehensively discuss the issue of FBP induced neurotoxicity. We suggest that much of this information supports the role of a theoretical model, the neuro-immune-endocrine system, in organizing and helping to explain the complex pathogenesis of FBP neurotoxicity.
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Affiliation(s)
- L H Garthoff
- United States FDA, Center for Food Safety & Applied Nutrition, Office of Applied Research and Safety Assessment, Division of Toxicology and Nutrition Product Studies, Neurotoxicology Branch, Laurel, MD 20708, USA.
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23
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Abstract
The onset of autoimmunity in lupus-prone mice is accompanied by a constellation of behavioral deficits, termed Autoimmunity-Associated Behavioral Syndrome (AABS). In particular, a spontaneous increase in serum interleukin-6 (IL-6) levels in five-week old MRL-lpr mice coincides temporally with blunted responsiveness to sucrose and excessive immobility in the forced swim test. These relationships, along with evidence that sucrose intake drops after systemic IL-6 overexpression is induced in healthy mice, have led to the hypothesis that sustained elevation in serum IL-6 also induces other aspects of AABS. This hypothesis is tested by comparing the behavioral profiles of healthy mice infected with Ad5mIL6 adenovirus (2 x 10(8) pfu of virus/mouse i.p.) with those of animals infected with control Ad5 virus. This methodology was used to achieve high circulating levels of IL-6, to overcome the problem of its short half-life, and to avoid the stressful effects of repeated injections. The Ad5mIL6 infection (known to induce excessive IL-6 levels over five days) transiently reduced food, water, and sucrose intake, as well as rectal temperature in MRL +/+ and AKR/J mice. Although the level of locomotor activity did not decline, Ad5mIL6-infected AKR/J mice demonstrated less novel object exploration. Performance in the step-down, plus-maze, and spontaneous alternation tests were disturbed to various degrees in all infected animals. The present results suggest that prolonged exposure to circulating IL-6 primarily impairs ingestive behavior, likely reflecting enhanced catabolism. The inability of circulating IL-6 to alter other aspects of behavior supports the hypothesis that multiple immuno-neuroendocrine mechanisms contribute to the pathogenesis of AABS.
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Affiliation(s)
- B Sakić
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
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24
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Trysberg E, Carlsten H, Tarkowski A. Intrathecal cytokines in systemic lupus erythematosus with central nervous system involvement. Lupus 2001; 9:498-503. [PMID: 11035414 DOI: 10.1177/096120330000900704] [Citation(s) in RCA: 115] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Symptoms originating from central nervous system (CNS) are frequently occuring in patients with systemic lupus erythematosus (SLE). Reliable diagnostic markers for this condition are presently lacking. Importantly, CNS involvement in lupus patients is associated with increased morbidity and mortality. The aim of this retrospective evaluate was to study the diagnostic value of cerebrospinal fluid (CSF) cytokine levels in SLE patients with CNS involvement. 34 patients with SLE were hospitalized and investigated for the presence of CNS lupus. These patients were evaluated clinically and with magnetic resonance imaging (MRI) and CSF analyses, as well as with neuropsychiatric tests. 13 patients were found to have CNS lupus whereas another four of the patients fulfilled the criteria for CNS involvement but were excluded from this group due to other causes of CNS involvement. Lastly, in 17 SLE cases, the diagnosis of CNS lupus could not be confirmed. CSF levels of interleukin-6 (IL-6) and IL-8, as well as the CSF/serum IL-6 ratio, were elevated in the CNS lupus group, compared with the 17 SLE patients not fullfilling a diagnosis of cerebral lupus. Interestingly, follow-up of five patients being successfully treated for CNS lupus revealed profound decrease of intrathecal IL-6 levels. These results indicate that analysis of CSF cytokine levels, especially IL-6 and IL-8, may be useful in the diagnostics and possibly follow-up of SLE patients with cerebral lupus.
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Affiliation(s)
- E Trysberg
- Department of Rheumatology, University of Göteborg, Sweden
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25
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Abstract
Aging modifies the clinical presentation and course of autoimmune disorders, although the mechanisms by which this occurs remain to be determined. Current evidence cited above supports the general concept that there is a natural senescence of the immune system. This evidence would suggest that somehow senescence directly affects gene expression, resulting in biochemical abnormalities that culminate in T-cell immunodysfunctions. This may be a principal factor that attenuates the autoimmune response to self-antigen and, therefore, the disease course. The authors speculate that there is a disorder primary to the T cell in SLE that is expressed as abnormal immunologic responses to self-antigens, resulting in autoimmunity. Although understanding of this primary T cell disorder is still limited, clinicians now know that the T cell harbors abnormal signaling pathways that reflect defective biochemical functions and seem to be genetically regulated. This aberrant signaling would be anticipated to affect both principal T cell subsets. It may hinder the capacity of cells, such as CD8 T cells, to effectively down-regulate the response of autoreactive CD4 helper T cells to autoantigens. Loss of self-regulation would manifest itself as loss of tolerance, a fundamental component of autoimmunity. The future challenge is to understand how aberrant signaling leads to loss of tolerance. Given this underlying genetic susceptibility in an aged individual whose T cells also are undergoing natural senescence, the authors suggest that it is conceivable that a stress factor may tip the balance in the favor of clinical disease. One such factor may be unspecified environmental stimuli. Yet another consideration is an intercurrent illness, such as an infection. It remains to be determined, however, what these environmental stimuli are and how they impact on the immune system to trigger disease.
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Affiliation(s)
- G M Kammer
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
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26
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Tkaczuk J, Bes JC, Duplan H, Sallerin B, Tafani M, Charlet JP, Abbal M, Lazorthes Y, Ohayon E. Intrathecal grafting of unencapsulated adrenal medullary tissue can bring CD4 T lymphocytes into CSF: a potentially deleterious event for the graft. Cell Transplant 2000; 9:79-91. [PMID: 10784070 DOI: 10.1177/096368970000900111] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Adrenal medullary tissue including chromaffin cells was grafted intrathecally in cancer patients to relieve intractable pain. The central nervous system (CNS) is considered an immune privileged site. Therefore, non-HLA-matched and unencapsulated tissue was grafted in 15 patients and 1 sham control in a series of at least 20 grafts. We observed an increase in CSF lymphocyte counts in 15/20 allografts (75%). In contrast to peripheral blood, CD4 T cells predominated in the CSF, but failed to exhibit an activated phenotype (CD25+ CD45RO+ HLA-DR+). The positive effect of graft on pain, the high met-enkephalin levels, the absence of any increase in CSF cytokine levels particularly for IFN-gamma or IL-2 (but not IL-10 and IL-6), indirectly indicated that the graft was tolerated despite the presence of CSF lymphocytes. The single treatment failure and three of four cases of partial efficacy occurred in grafts where CSF lymphocytes were present. Moreover, when assayed (n = 7), the CD4+ CSF lymphocytes still retained the capacity to exhibit ex vivo a normal or enhanced frequency of T CD4 cells producing IFN-gamma and IL-2. Taken together, our observations indicate that impairment of the local immunosuppressive balance can lead to activation of those CSF CD4 T cells and drive a rejection process. This study suggests further work on the purification and/or the immunoisolation of tissues grafted in the CNS will be necessary, particularly when the possibility of long-term and repeated grafting is considered.
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Affiliation(s)
- J Tkaczuk
- Immunology Department, Rangueil Hospital, and Rangueil Medical School, Paul Sabatier University, Toulouse, France.
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27
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28
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Nishino S, Mignot E, Benson KL, Zarcone VP. Cerebrospinal fluid prostaglandins and corticotropin releasing factor in schizophrenics and controls: relationship to sleep architecture. Psychiatry Res 1998; 78:141-50. [PMID: 9657418 DOI: 10.1016/s0165-1781(98)00012-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Sleep abnormalities have been consistently observed in patients with schizophrenia. Elevated levels of corticotropin releasing factor (CRF) and prostaglandins (PGs) in the cerebrospinal fluid (CSF) of patients with schizophrenia have been reported, and these neurochemical substances, known to modulate sleep in experimental animals, may play a role in these sleep abnormalities. In this study, we measured PGD2, PGE2, PGF2alpha and CRF levels in the CSF of 14 unmedicated schizophrenic patients and 14 age- and sex-matched control subjects. Polysomnographic recordings were also carried out for each subject. As expected, the sleep of the schizophrenic subjects significantly differed from that of the controls; schizophrenic subjects had a longer sleep onset latency, slept less, spent fewer minutes in stage 2 sleep and had a lower sleep efficiency. We could not, however, detect any differences in CSF CRF and PG levels between normal and schizophrenic subjects, nor could we find any correlation between CSF variables and sleep parameters in the schizophrenic subjects and the non-psychiatric controls. These results do not favor the hypothesis of a role for CRF or PGs in the pathophysiology of sleep disturbances in schizophrenia.
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Affiliation(s)
- S Nishino
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA 94305, USA.
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29
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Abstract
The improved survival of SLE patients since the 1950s is the result of not only better treatment, but also supportive treatment of renal failure and the wealth of antibiotics now available. Ironically, the wider use of immunosuppressives, especially the alkylating drugs, and the longer survival of patients with renal insufficiency and renal failure have made the identification and appropriate treatment of infection in SLE an ongoing challenge.
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Affiliation(s)
- M Petri
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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30
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Moore PM, Vo T, Carlock LR. Identification and cloning of a brain autoantigen in neuro-behavioral SLE. J Neuroimmunol 1998; 82:116-25. [PMID: 9585807 DOI: 10.1016/s0165-5728(97)00157-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
In murine models of SLE, particular patterns of abnormalities of social interaction and memory collectively known as neurobehavioral dysfunction (NBD) correlate with the occurrence of brain reactive autoantibodies. Study of the immunopathogenic effects of these antibodies has been limited by the absence of isolated autoantibodies and antigens. In order to identify the molecular targets, we isolated autoantibodies highly specific for brain plasma membranes from MRL/lpr mice. After immunoscreening a brain expression library with these brain specific autoantibodies, we identified a single cDNA clone of unique sequence and relevant anatomic distribution. Transcript for this cDNA is wide spread among mammalian species but appears to be present only in the brain. Addition features, suggesting this cDNA is pertinent for further study include (1) the expressed protein, called lupus brain antigen 1, reacts with the screening immunoglobulins as well as immunoglobulins from other strains of murine neuro-SLE not used to screen the library, but not with immunoglobulins from normal mice, (2) the transcript distribution within the brain is similar to immunochemical localization of binding of the spontaneous autoantibodies and (3) the localization of transcript within the brain, in the hippocampus, hypothalamus an cingulate gyrus, corresponds to anticipated anatomical regions of clinical dysfunction. Further, the transcript is a large, potentially structural molecule of unique sequence. Antibodies to this molecule may mediate changes in behavior either by direct interactions with the cognate antigen or by indirect influences through neuro-endocrine axes.
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MESH Headings
- Amino Acid Sequence
- Animals
- Autoantigens/analysis
- Autoantigens/genetics
- Autoantigens/metabolism
- Base Sequence
- Behavior, Animal/physiology
- Blotting, Western
- Brain/immunology
- Brain/metabolism
- Cloning, Molecular
- DNA, Complementary/isolation & purification
- Fluorescent Antibody Technique, Indirect
- Humans
- In Situ Hybridization
- Lupus Erythematosus, Systemic/immunology
- Lupus Erythematosus, Systemic/physiopathology
- Lupus Erythematosus, Systemic/psychology
- Mice/embryology
- Mice, Inbred BALB C
- Mice, Inbred MRL lpr
- Mice, Inbred NZB
- Molecular Sequence Data
- Nervous System/physiopathology
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Affiliation(s)
- P M Moore
- Department of Neurology and Molecular Genetics, Wayne State University School of Medicine, Detroit, MI 48201, USA
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31
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Sakić B, Szechtman H, Braciak T, Richards C, Gauldie J, Denburg JA. Reduced preference for sucrose in autoimmune mice: a possible role of interleukin-6. Brain Res Bull 1997; 44:155-65. [PMID: 9292205 DOI: 10.1016/s0361-9230(97)00107-x] [Citation(s) in RCA: 76] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
In a continuous one-bottle sucrose intake test, 4-month-old autoimmune MRL-Ipr mice show a shift to the right along the X-axis of the concentration-intake function, compared to congenic MRL +/+ controls. Using a brief (60-min) and a continuous (48-h) two-bottle test, the present report examines potential factors that could account for the reduced responsiveness to a palatable stimulus. Study 1 examines whether preference for sucrose is associated with age, changes in food/water intake, or impaired renal function. Reduced preference for sucrose was observed in 5-6-week-old MRL-Ipr males, although food/water intake or blood creatinine levels did not differ from control values. Immunosuppressive treatment abolished this deficit, suggesting a role of immune factor(s). Study 2 tests the hypothesis that chronic upregulation of the neuroactive cytokine interleukin-6 (IL-6), reported to occur from 3 weeks of age in young MRL-Ipr mice, reduces preference for sucrose. Sustained administration of IL-6 was produced by infecting healthy MRL +/+, C3H.SW and Balb/C mice with adenovirus vector carrying cDNA for murine IL-6. This resulted in high serum IL-6 levels over 5 days, a rapid decline in preference for sucrose and low blood glucose levels. The results from Study 1 indicate that impaired sensitivity to sucrose in MRL-Ipr mice can be detected before autoimmune disease is florid in MRL-Ipr mice. The results from Study 2 are consistent with altered motivation/emotional states after infection, and point to sustained IL-6 production as an early mechanism in behavioral alterations during chronic autoimmune/inflammatory conditions.
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Affiliation(s)
- B Sakić
- Department of Psychiatry, McMaster University, Hamilton, Ontario, Canada
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Affiliation(s)
- P M Moore
- Department of Neurology, Wayne State University School of Medicine, Detroit, Michigan 48201, USA
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Bell MJ, Kochanek PM, Doughty LA, Carcillo JA, Adelson PD, Clark RS, Wisniewski SR, Whalen MJ, DeKosky ST. Interleukin-6 and interleukin-10 in cerebrospinal fluid after severe traumatic brain injury in children. J Neurotrauma 1997; 14:451-7. [PMID: 9257663 DOI: 10.1089/neu.1997.14.451] [Citation(s) in RCA: 187] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Cytokines may play an important role in the pathophysiology of traumatic brain injury (TBI) in children. Interleukin-6 (IL-6) is a proinflammatory cyotkine that plays a role in regenerative processes within the central nervous system (CNS), whereas interleukin-10 (IL-10) is an antiinflammatory cytokine. Both have been measured in serum and cerebrospinal fluid (CSF) as an index of the degree of inflammation in diseases, including sepsis and meningitis. We hypothesized that both IL-6 and IL-10 would be increased in the CSF of children after severe TBI. Fifteen children who sustained severe TBI (Glascow Coma Score [GCS] < or = 7) were studied. Standard neurointensive care was provided. Ventricular CSF collected the first 3 days after TBI was analyzed for IL-6 and IL-10 concentrations by ELISA. Controls were 20 children who were evaluated for meningitis with diagnostic lumbar puncture subsequently found to have no CSF pleocytosis and negative cultures. IL-6 was increased in children after TBI versus controls on all days studied (day 1, 3158.2 +/- 621.8 pg/ml; day 2, 1111.6 +/- 337.0 pg/ml; day 3, 826.7 +/- 193.5 pg/ml vs. 20.6 +/- 5.8 pg/ml, p < 0.0001, Mann-Whitney Rank Sum). IL-10 was increased in children after TBI vs controls on all days studied (day 1, 47.2 +/- 12.9 pg/ml; day 2, 21.0 +/- 6.7 pg/ml; day 3, 15.5 +/- 5.9 pg/ml vs. 8.9 +/- 7.5 pg/ml, p < 0.01). Increased IL-10 concentrations were independently associated with age < 4 years and mortality (p = 0.004 and 0.04, respectively, multivariate linear model). This study demonstrates that IL-6 is increased after TBI in children to levels similar to those reported in adults and is the first to show that IL-10 is increased in CSF of humans after TBI. These data suggest that there may be an age-dependent production of IL-10 after TBI in children.
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Affiliation(s)
- M J Bell
- Department of Anesthesiology and Critical Care Medicine, Safar Center for Resuscitation Research, University of Pittsburgh, Pennsylvania 15260, USA
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Abstract
Inbred MRL, NZB and BXSB strains of mice spontaneously develop a systemic, lupus-like autoimmune disease. The progress of autoimmunity is accompanied with a cascade of behavioral changes, most consistently observed in tasks reflective of emotional reactivity and the two-way avoidance learning task. Given the possibility that behavioral alterations may reflect a detrimental consequence of autoimmune-inflammatory processes and/or an adaptive response to chronic malaise, they are tentatively labeled as autoimmunity-associated behavioral syndrome (AABS). It is hypothesized that neuroactive immune factors (pro-inflammatory cytokines, brain-reactive antibodies) together with endocrine mediators (corticotropin-releasing factor, glucocorticoids) participate in the etiology of AABS. Since AABS develops natively, and has a considerable face and predictive validity, and since the principal pathway to autoimmunity is known, AABS may be a useful model for the study of CNS involvement in human autoimmune diseases and by extension, for testing autoimmune hypotheses of several mental disorders (major depression, schizophrenia, Alzheimer's disease, autism and AIDS-related dementia).
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Affiliation(s)
- B Sakić
- Department of Biomedical Sciences, McMaster University, Hamilton, Ontario, Canada
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Li AJ, Katafuchi T, Oda S, Hori T, Oomura Y. Interleukin-6 inhibits long-term potentiation in rat hippocampal slices. Brain Res 1997; 748:30-8. [PMID: 9067442 DOI: 10.1016/s0006-8993(96)01283-8] [Citation(s) in RCA: 119] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The effects of recombinant human interleukin-6 (rhIL-6) on long-term potentiation (LTP) induced in the Schaffer collateral/commissural-CA1 pathway were examined using rat hippocampal slices. Field excitatory postsynaptic potential was recorded in the stratum radiatum of the CA1 region. Ten-min applications of rhIL-6 (50-2000 U/ml), started 5 min before the tetanus, significantly inhibited the induction of LTP, and in high doses of rhIL-6 also inhibited short-term potentiation (over 200 U/ml) and post-tetanic potentiation (over 500 U/ml). The effects of rhIL-6 (500 U/ml) were completely abolished by the preincubation of the slices with monoclonal anti-IL-6 receptor antibody (16 microg/ml) for 2 h. Heat-inactivated rhIL-6 had no effect on the synaptic potentiation. RhIL-6 affected neither the previously established LTP nor the basal synaptic transmission. These findings indicated that rhIL-6 modulated synaptic potentiation through the IL-6 receptor-mediated process in the hippocampus, probably by affecting post- and presynaptic sites in the CA1 region. The possible mechanisms of the IL-6-induced suppression of the synaptic potentiation were discussed.
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Affiliation(s)
- A J Li
- Department of Physiology, Faculty of Medicine, Kyushu University, Fukuoka, Japan
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Abstract
Dysregulation of IL-6 production has been proposed as a pathogenic mechanism in SLE. We asked if serum or urine IL-6 levels could serve as indicators of systemic lupus erythematosus (SLE) disease activity. Using a sensitive enzyme-linked immunosorbent assay (ELISA), we measured serum and urine IL-6 in 56 SLE patients. Disease activity was assessed using a standard clinical index, the Systemic Lupus Activity Measure (SLAM). Only seven of 56 SLE patients had elevated serum IL-6 levels, compared with 1 of 32 controls (NS). SLE disease activity did not correlate with serum IL-6 levels. Sixteen of 50 SLE patients in whom urine IL-6 was measured exhibited elevated urine IL-6 levels, compared with 1 of 17 controls (p = < 0.05). Urine IL-6 levels correlated with overall disease activity and with the presence of active urinary sediment. Our results indicate that serum IL-6 is not a predictor of disease activity in SLE, but that urine IL-6 may be a marker of active nephritis.
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Affiliation(s)
- E Peterson
- Division of Rheumatology, University of Iowa College of Medicine, Iowa City, USA
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Levy EI, Paino JE, Sarin PS, Goldstein AL, Caputy AJ, Wright DC, Sekhar LN. Enzyme-linked immunosorbent assay quantification of cytokine concentrations in human meningiomas. Neurosurgery 1996; 39:823-8; discussion 828-9. [PMID: 8880778 DOI: 10.1097/00006123-199610000-00036] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE To gain insight into the network of cytokine gene expression in the brain tumor microenvironment, we investigated the presence of the following cytokines in freshly excised brain tumors: interleukin (IL)-1 beta, IL-2, IL-4, and IL-6. METHODS Tumor specimens from nine meningiomas were grown as tissue explants. The supernatants from the explants were tested for the presence of the aforementioned cytokines via the enzyme-linked immunosorbent assay method. RESULTS IL-6, which is thought to stimulate acute protein phase synthesis, neovascularization, and cell proliferation, was found in all of the samples in greater concentrations than the other cytokines tested. IL-1 beta, another stimulatory cytokine thought to be involved in acute protein phase synthesis and cell proliferation, was also found in 100% of the samples tested, in concentrations significantly lower than those of IL-6. As expected, the presence of IL-2 and IL-4 was not detectable in any of the samples. CONCLUSION This study is the first to clearly determine the relative concentrations of IL-1 beta and IL-6, using enzyme-linked immunosorbent assay quantification. These findings are an important precursor to future studies using antibodies to IL-1 beta and IL-6 and antibodies to IL-6 receptors to modulate neoplastic growth both in vitro and in vivo.
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Affiliation(s)
- E I Levy
- School of Medicine, George Washington University, District of Columbia, USA
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Fox RA, Moore PM, Isenberg DA. Neuroendocrine changes in systemic lupus erythematosus and Sjögren's syndrome. BAILLIERE'S CLINICAL RHEUMATOLOGY 1996; 10:333-47. [PMID: 8911652 DOI: 10.1016/s0950-3579(96)80020-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
It has become clear that the neuroendocrine and immune systems are closely linked and interdependent. The exact mechanisms of this interaction are only beginning to be unravelled. The complexity of these connections may partly explain why the aetiopathogenesis of autoimmune diseases remains obscure and why genetic, hormonal, microbial, environmental, as well as a host of other factors, have all been put forward as explanations. What has become clear is that a number of neuroendocrine and hormonal factors have important immunomodulatory roles in health and disease.
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Affiliation(s)
- R A Fox
- Whittington Hospital, London, UK
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